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requests based on clinical need and urgencydetermined by the vascular surgeon on call. Several re-spondents noted the creation and establishment of amobile vascular laboratory program that provided in-home services for select types of patients.DISCUSSIONThe COVID-19 pandemic has changed the landscape ofsurgical practice in the United States, including cancella-tion and postponement of elective surgical cases andrapid dissemination of surgical practice guidelines withthe goal of to preserving PPE and build capacity withinhealth care systems.1,3,11-15This survey covers the periodof April 14 to 24, 2020, during which cases in the UnitedStates rose increased 492,416 to 895,766, with the North-eastern region being most heavily affected.16The majority of survey respondents implemented spe-cific operating room protocols and had adequate PPEat their primary institution. In areas where shortageswere evident or expected, such as the Northeast region,active measures by hospital leadership were institutedto convert PACU and operating rooms to ICU beds toallow for the surge, with operating rooms and PACUs be-ing suitable based on their location, size, and availableinfrastructure.17ICUs were the most full in the Northeast,with a significant increase in patients boarded in thePACU/operating rooms as compared with the rest ofthe country.With surgical guidelines for the pandemic in place andendorsed by surgical societies,2,3elective vascular surgi-cal cases were decreased significantly, if not haltedcompletely. Not surprisingly, the majority of the respon-dents canceled elective cases, adhering to guidelinesset forth by national surgical and specialty societies,such as the ACS and the SVS.3,6The West/Southwest re-gion had the fewest number of cancellations, which mayrepresent the lower number of the COVID-19 cases with adownward trend at the time of this survey; Washingtonstate was ground zero for the pandemic in the UnitedStates. Although only one-half of the respondents hadpreoperative COVID-19 testing for their patients, an over-whelming majority identified dedicated COVID-19 oper-ating protocols at their institutions. There was nogeographic variation in preoperative testing of patientsfor COVID-19, presence of OR protocols and PPE, oradherence to national guidelines. A focus on life-over-limb was clearly demonstrated, with the majority ofcontinued elective cases focused on aortic repair andmaintenance of dialysis function rather than peripheralarterial disease or venous procedures.Table I.Description of the 535 vascular surgeons whoresponded to the survey and their practicesCharacteristicsNo. (%)RegionNortheast138 (25.8)Southeast122 (22.8)Midwest126 practice only11 (2.1)Solo22 (4.1)Veterans’Affairs or government run27 (5)Hospital size, beds<504 (.7)50-994 (.7)100-20049 (9.2)201-30091 (17)301-40083 (15.5)>400252 (47.1)Don’t know or no response46 (8.6)I do not work at a hospital6 (1.1)Practice at more than one hospital307 (57.4)Leadership positiona320 (59.8)a“Do you have an institutional leadership position (eg, program direc-tor, vascular lab director, section head, division head, departmentchair)?”JournalofVascularSurgeryMouawad et al775Volume 73, Number 3 1311-1516172336 Along with other healthcare workers, vascular surgeonshave been redeployed to perform critical activities dur-ing the pandemic that are not part of their routine prac-tice, similar to what has been seen in other specialties.11-15The most common redeployment was to the ICU, as wellas the formation of central line teams to minimize multi-provider exposure and leverage the expertise of vascularsurgeons. As expected, redeployment was most com-mon in areas most affected by the
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